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Standardized endotracheal tube and intravascular access placement in infants born at 22-23 weeks gestation

Nima Naseh1, Linda Wallström2, Richard Sindelar2

  • 1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. nima.naseh@uu.se.

Pediatric Research
|June 18, 2025
PubMed

Insights

Accurate placement of endotracheal tubes (ETT) and umbilical catheters (UC) is crucial for extremely preterm infants. This study provides standardized insertion depths for 22-23 week gestation infants, improving delivery room care and infant outcomes.

Area of Science:

  • Neonatal medicine
  • Pediatric critical care
  • Perinatal research

Background:

  • Limited guidance exists for endotracheal tube (ETT) and umbilical catheter (UC) placement in extremely preterm infants (22-23 weeks gestation).
  • Accurate positioning is vital for effective treatment and minimizing complications in this vulnerable population.

Purpose of the Study:

  • To determine optimal insertion depths for ETT and UC in infants born at 22-23 weeks gestation.
  • To assess the impact of ETT malposition on respiratory outcomes and mortality.

Main Methods:

  • Radiological evaluation of ETT and UC positions in infants born at 22-23 weeks gestation (2019-2024).
  • Defined accurate positions: ETT (mid-trachea), UAC (T6-9/L3-4), UVC (right atrium/IVC junction).
  • Analyzed ETT position in relation to respiratory severity, ventilation duration, BPD, and mortality.

Main Results:

  • Survival rates were 41% (22w) and 64% (23w).
  • Accurate ETT placement achieved in 75%; lower birth weight correlated with deeper ETT tip position.
  • Optimal median insertion depths: ETT 5.5 cm, low UAC 6.0 cm, high UAC 9.6 cm, UVC 5.5 cm.

Conclusions:

  • Suggested insertion depths facilitate accurate ETT and UC positioning in 22-23 week gestation infants.
  • Standardized, gestational age-based insertion depths are feasible and improve delivery room management.
  • ETT position did not significantly impact respiratory outcomes or mortality in this cohort.
Abstract

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